Welcome to the Perio Centre

New Employee Form

Title:

First Name *

Last Name *

Prefered Name:

Date of Birth *

Mobile Number *

Email Address *

Home Address: *

Tax Details

Please download and complete your Tax File Number Declaration Form as soon as possible.

TFN Form Download

Tax File Number

TFN Declaration Upload

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Bank Details

Name account is held under *

BSB *

Account Number *

Superannuation Fund Details

Superannuation Fund Name

Member number

Medical Information

Do you have any Allergies, if so please advise:

How should you be managed in an emergency?

Do you have any medical conditions or take any medications that we need to be aware of:

Name of Medical Doctor:

Emergency Contact

Emergency Contact Name *

Relationship *

Phone Number *

Immunisation Acknowledgement:

The Perio Centre institutes an occupational vaccination program for all practitioners and staff, and maintains a immunisation register which documents which person has received which vaccinations, whether this has resulted in an immunised status, proof of their vaccination and the date at which their immunisation record will next be reviewed.

This is considered an integral component of our infection control protocols.

We request that you provide a verified vaccination status (a letter from your GP will suffice) as a part of pre-employment documentation.

Staff members can refuse vaccination, or to disclose their immunisation status; however it is imperative they are made aware of, and understand, the risks of workingin a clinical environment without proper immunity. This should be done in writing and signed by the staff member.

While restrictions can be placed upon a staff member refusing vaccination or the disclosure of their status, imposing these in a workplace is a complex matter and shouldn’t be undertaken lightly.

Please note staff performing/ assisting exposure prone procedures should have their serology tested every three years.

Addition Vaccinations May Include:

DiptheriaTetanusHepatitis A

I will provide you with a recent signed serology report.

I am aware of the risks of contracting disease during my employment. I am aware of the benefits of the vaccinations explained to me however I choose not to provide you with my serology report.

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